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Paediatric Conditions We See > Hip

Slipped Capital Femoral Epiphysis (SCFE)

 

Slipped Capital Femoral Epiphysis (SCFE) is a hip disorder that commonly affects children and adolescents during periods of rapid growth. It occurs when the femoral head, which connects to the growth plate at the top of the thigh bone (femur), slips off the neck of the bone. This displacement can interfere with normal hip joint function and movement, often leading to pain, stiffness, and instability in the affected hip.

1. Stable SCFE
In most cases, SCFE is stable, meaning the patient can bear weight on the affected hip without the need for walking aids. The symptoms may include mild pain and limited range of motion, but the individual can still walk.

 

2. Unstable SCFE

In contrast, unstable SCFE is more severe. The patient is unable to put any weight on the affected hip, even with walking aids. This type is considered a medical emergency and requires immediate treatment due to the risk of further complications.

There is no known cause for a SCFE. However, there are various factors associated with the condition. These factors include:

  • Growth Spurts: SCFE commonly occurs during periods of rapid growth, making the growth plate more vulnerable and increasing the risk of the femoral head slipping off the neck of the bone.
  • Excessive Body Weight: Excessive weight can add further stress on the hip joint, increasing the risk of SCFE
  • Family History: A family history of SCFE may increase the likelihood of developing the condition.

  • Endocrine or Metabolic Disorders: Conditions such as hypothyroidism or hyperthyroidism can also be linked to an increased risk of SCFE.

The symptoms vary depending on the severity of the condition. A patient with stable SCFE may experience intermittent groin, hip, knee, and thigh pain that gradually worsens over time, walking with a slight limp and an out-toed gait due to increased external rotation. However, a patient with unstable SCFE may experience a sudden onset of pain (usually after a fall or injury), an inability to put weight on the affected leg, an outward turning of the leg, and a difference in leg length, wherein the affected leg may appear shorter than the other.

 

SCFE treatment usually requires surgery to prevent further displacement of the femoral head. A procedure used to treat SCFE is in situ fixation, in which the surgeon makes a small incision near the hip and inserts a metal screw across the growth plate to help maintain the position of the femoral head, preventing any further slippage.

In situ fixation is commonly used to treat patients with stable SCFE. Another surgical treatment is called open reduction. During an open reduction, the surgeon makes an incision in the hip to gently manipulate the femoral head back into position.

Once the femoral head is in its original anatomical position, one or two metal screws are inserted to keep the bone in place until the growth plate closes. An open reduction is typically used to treat patients with unstable SCFE.

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